Abnormal Placentation After Caesarean Section: A Retrospective Study

TL;DR

This study examines complications like abnormal placentation in pregnancies following a caesarean section, highlighting the need for early detection to prevent life-threatening outcomes.

Contribution

The study provides insights into the frequency and types of placental complications in post-caesarean pregnancies through a retrospective analysis.

Findings

Three cases of tubal ectopic pregnancy and two cases of scar ectopic pregnancy were identified.

Five cases of placenta previa and three cases of morbidly adherent placenta were observed.

Two obstetrical hysterectomies were performed due to complications.

Abstract

Introduction

Caesarean section (CS) is a lifesaving operation; it can have many complications in subsequent pregnancies. Since the uterine wall and cavity are not normal after CS, the implantation and subsequent trophoblastic invasion and placenta formation may be affected. This study was carried out to find out implantation and placental problems encountered in subsequent pregnancies. The spectrum includes placenta accreta, increta, and percreta and is characterized microscopically by a complete or partial absence of decidua and placental adherence to or invasion of the myometrium. The study was performed to find out the complications of CS in subsequent pregnancies and take measures to detect them early and take appropriate action.

Materials and methods

This retrospective study was carried out at Dr. D.Y. Patil Medical College and Research Centre Pimpri, Dr DY Patil Vidyapeeth, a large tertiary care centre. Many complications like placenta previa, adherent placenta, ectopic pregnancy, obstetrical hysterectomy, etc, the ones directly related to implantation and placentation, were recorded and compared with the literature.

Results and observations

The study was over a period of three years. During this period, there were 10,296 antenatal cases registered; of all the registered cases, 2,544 were cases of post-caesarean pregnancy. There were three cases of tubal ectopic pregnancy, two were diagnosed as the patients complained of amenorrhoea, spotting, and pain abdomen, confirmed on sonography and one was picked up on a routine first-trimester scan. There were two cases of scar ectopic pregnancy. Both the cases were diagnosed as threatened abortion initially and ultrasound confirmed the diagnosis; both were managed medically. Five cases of placenta previa were encountered. There were three cases of morbidly adherent placenta, and two cases underwent obstetrical hysterectomy.

Conclusion

All surgical procedures have become safe, but they all have some complications. Many complications in the next pregnancy after caesarean are life-threatening and dangerous. These complications should be detected early to prevent any catastrophic event.

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